MOLECULAR IMAGING

Molecular imaging is a type of medical imaging that provides detailed pictures of what is happening
inside the body at the molecular and cellular level. Where other diagnostic imaging proceduressuch
as x-rays, computed tomography (CT) and ultrasoundoffer pictures of physical structure, molecular
imaging allows physicians to see how the body is functioning and to measure its chemical and
biological processes.1
Unlike conventional imaging studies that produce primarily structural pictures, nuclear medicine and
molecular imaging visualize how the body is functioning and whats happening at the cellular and
molecular level. The evolution in diagnostic imagingfrom producing anatomical pictures to imaging
and measuring the bodys physiological processesis critically important to all facets of medicine
today, from diagnosing disease at its earliest stage and developing more effective therapies to
personalizing medical treatment.2
Molecular imaging includes the field of nuclear medicine, which uses very small amounts of radioactive
materials (radiopharmaceuticals) to diagnose and treat disease. In nuclear medicine imaging, the
radiopharmaceuticals are detected by special types of cameras that work with computers to provide
very precise pictures of the area of the body being imaged. Nuclear medicine can also be used to treat
certain types of cancer and other diseases.1
Molecular imaging offers unique insights into the human body that enable physicians to personalize
patient care. In terms of diagnosis, molecular imaging is able to:

provide information that is unattainable with other imaging technologies or that would require
more invasive procedures such as biopsy or surgery

identify disease in its earliest stages and determine the exact location of a tumor, often before
symptoms occur or abnormalities can be detected with other diagnostic tests. 1

As a tool for evaluating and managing the care of patients, molecular imaging studies help physicians:

determine the extent or severity of the disease, including whether it has spread elsewhere in
the body

select the most effective therapy based on the unique biologic characteristics of the patient
and the molecular properties of a tumor or other disease

determine a patients response to specific drugs

accurately assess the effectiveness of a treatment regimen

adapt treatment plans quickly in response to changes in cellular activity

assess disease progression

identify recurrence of disease and help manage ongoing care. 1

In conventional diagnostic imaging, an external source of energy such as x-rays, magnetic fields or
ultrasound waves is used to produce pictures of bone and soft tissue. In nuclear medicine and
molecular imaging procedures, the energy source is introduced into the body, where it
gets incorporated in a specific tissue, organ or process and is then detected by an external device
(gamma camera, SPECT or PET scanners) to provide information on organ function and cellular
activity. 2
Because disease begins with microscopic cell changes, nuclear medicine and molecular imaging have
the potential to identify disease in an earlier, more treatable stage, often before conventional imaging
and other tests are able to reveal abnormalities. To obtain this unique information without nuclear

medicine and molecular imaging tests would require more invasive proceduressuch as biopsy or
surgeryor would simply be unattainable. With their ability to identify the early signs of disease and
other abnormalities, nuclear medicine and molecular imaging offer the potential to change medical
care from reactive to proactive, saving and improving countless lives.2

Nuclear medicine and molecular imaging are integral to the care of patients with cancer, heart disease
and brain disorders:

Lymphoma and esophageal, colon and lung cancer are just a few of the many types of cancer
for which nuclear and molecular imaging can truly change the direction and outcome of patient
care.

Nuclear medicinethrough myocardial perfusion imagingoffers a very accurate test for

diagnosing coronary artery disease in patients who may be at risk for a heart attack.

In addition to helping physicians diagnose dementia, nuclear imaging now offers imaging
agents
that
successfully identify early changes
in the
brain associated
with
Alzheimers disease.2

Examples of anatomical imaging (CT) compared to functional imaging (PET).

In this patient, the CT scan (A) is negative for disease recurrence. However, the PET scan (B)
shows a spot suggesting malignancy. The PET/CT fusion image (C) gives a clearer picture of what
is happening. Reference: http://jnm.snmjournals.org/content/49/6/938

In the laboratory, nuclear medicine and molecular imaging technologies are helping scientists in a
variety of disciplines gain a better understanding of the molecular pathways and mechanisms of
disease. By helping researchers quickly assess new therapies, nuclear medicine and molecular imaging
are also contributing to the accelerated development of new and more effective drugs.2
Nuclear
medicine
and
molecular
imaging
involve
a
signalproducing imaging
agent
(radiopharmaceutical or probe) that is introduced into the body, usually by injection, and an imaging

device capable of detecting and using the probes signals to create detailed images. Probes, which are
designed to accumulate in a specific organ or attach to certain cells, enable cell activity and biological
processes to be visualized and measured.2
In nuclear medicine, the imaging agent is a compound that includes a small amount of radioactive
material called a radiotracer. Radiotracers (which are also called radiopharmaceuticals or
radionuclides) produce a signal that can be detected by a gamma camera or a positron emission
tomography (PET) scanner. Non-nuclear molecular imaging modalities, including optical imaging and
targeted ultrasound, use nonradioactive probes such as light or sound. MR spectroscopy uses
differences in magnetism to measure chemical levels in the body without the use of a probe.2
Positron Emission Tomography (PET) Imaging

Before a PET scan begins, a patient is given a safe dose of a radioactive tracer compound. To measure
brain activity, doctors and scientists use FDG (fluorodeoxyglucose), which is a modified glucose molecule.
Glucose is a type of sugar, and it is the main energy source for brain cells. The injected or inhaled FDG
will enter the bloodstream, where it can travel to the brain. If a particular area of the brain is more active,
more glucose or energy will be needed there. When more glucose is used, more radioactive material is
absorbed.3

For example, highly active cancer cells show higher levels, or uptake, of FDG, whereas brain cells
affected by dementia consume smaller amounts of glucose and show lower FDG uptake. In addition to
FDG, other PET radiotracers are available to visualize a large variety of cancerous and noncancerous
processes.2

The PET scanner measures energy that is emitted when positrons (positively charged particles) from the
radioactive material collide with electrons (negatively charged particles) in the person's brain. The scan
usually takes between 30 minutes and two hours. A computer turns energy measurements into
multicolored, two- or three-dimensional images. The result is a colorful picture showing which parts of the
brain were most active, based on the amount of glucose being used there.3
PET can determine within several days whether a therapy is working, whereas it would take months to
evaluate a change in the size of the tumor with CT. Researchers hope that information from PET
studies will soon help physicians predict which patients will respond to a specific chemotherapy drug.
New radiotracers are also being designed to identify biological conditions within the body (called
biomarkers) that signal the presence of cancer and to capture important information on tumors that

will guide physicians in selecting the most effective treatment plan. PET is a powerful tool for
diagnosing cancer and determining the severity and extent of cancer. PET scans are one of the most
effective means of detecting a recurrence of disease. PET scans are also increasingly being used to
quickly assess how a patient responds to cancer treatment. 2

Single-photon emission computed tomography (SPECT) Imaging

SPECT is a very significant and common imaging procedure that also involves the injection of a
radiotracer into the patients bloodstream, where it accumulates in a target organ or attaches to
specific cells. A gamma camera then rotates around the patient, collecting data to create threedimensional images of radiotracer distribution that reveal information on blood flow and
organ function. Many SPECT studies are combined with CT studies.2
In some cases, PET and SPECT studies are regularly used to detect blockages in the coronary arteries,
assess muscle damage following a heart attack, and determine whether the heart is pumping blood
adequatelyespecially when stressed. New radiotracers offer the potential to identify individuals at
risk for sudden cardiac death or showing signs of congestive heart failure. Both PET and SPECT are
highly useful in detecting dementia, evaluating ongoing cognitive decline and identifying the area of
the brain involved in seizure disorders. Researchers using new PET radiotracers recently scored a
major breakthrough when they identified the early changes in the brain associated with Alzheimers
disease.2
SPECT is also helpful in identifying the location and cause of a stroke, as well as areas of the brain
that are at risk following a stroke. A newly approved radiotracer for SPECT (called DaTscan) is
expected to help evaluate the cause of tremors and to differentiate between essential tremor and
Parkinsonian syndromes. Researchers using PET and SPECT are gaining new insights into the biology
of psychiatric disease, drug addiction and neurological disorders. Understanding how brain circuitry is
altered in people with brain disorders is critical to the development of new treatments and
prevention strategies.2

Optical Imaging
The field of optical imaging includes numerous technologies that use light to measure cell function and
characteristics. Scientists engineer tiny molecules, such as proteins that naturally emit light, to attach
to specific cells or chemicals inside the body. Highly sensitive optical detectors are able to track the
movement and activity of these imaging agents and to measure how tissue absorbs light.

An essential tool for basic research, optical imaging has the potential to help patients in the future by:

Detecting lymphoma and ovarian, skin and breast cancer.

Monitoring patient response to therapy.

Delivering medication directly to cancer cells.

Guiding surgery.2

Targeted Molecular Ultrasound

Traditional ultrasound imaging, which uses high-frequency sound waves to produce pictures of the
inside of the body, is a standard imaging procedure with many applications. In targeted molecular
ultrasound imaging, microbubblesextremely small, hollow structuresor other microscopic particles
(called nanoparticles) serve as an imaging agent. Scientists are able to chemically modify
microbubbles to target specific tissue within the body, where they produce signals that reveal
molecular information.2
Targeted molecular ultrasound may be useful for:

Diagnosing breast, ovarian, head and neck and other cancers

Measuring blood flow within the heart and other organs.

Identifying coronary artery disease and other blood vessel abnormalities.

By encapsulating medication within microbubbles, targeted molecular ultrasound technology also

has potential as a means of targeted drug delivery.2
Magnetic Resonance Spectroscopy
Magnetic resonance (MR) spectroscopy is a variation of conventional MR imaging that provides
information on the concentration of chemical compoundscalled metabolitesinside the body. MR
spectroscopy aids in the diagnosis and treatment of cancer and metabolic disordersespecially those
affecting the brain. Researchers also hope MR spectroscopy will prove helpful in detecting recurring
cancer, as a guide for radiation therapy and in distinguishing malignant from healthy tissue in the
breast and prostate. 2
Therapy
The cell-targeting ability of nuclear and molecular imaging agents offers an excellent means of
delivering treatment. In fact, one of the earliest applications of nuclear medicineradioactive iodine
(I-131) ablationhas been a highly successful treatment for thyroid cancer and hyperthyroidism for
more than half a century. In I-131 targeted radionuclide therapy (TRT), radioactive iodine is
introduced into the body and absorbed by the thyroid cells or thyroid cancer cells, where it kills them.
TRT is now being used to treat other forms of cancer and to provide pain relief to some bone cancer
patients. The treatment of non-Hodgkin lymphoma with radioimmunotherapeutics such as Zevalin is
an effective form of TRT.2

1. http://www.snmmi.org/AboutSNMMI/Content.aspx?
ItemNumber=6433&navItemNumber=756 diakses 6 juni 2015
2.
http://www.snmmi.org/AboutSNMMI/Content.aspx?ItemNumber=5648
diakses 6 juni 2015
3. http://learn.genetics.utah.edu/content/addiction/brainimaging/ diakses
6 juni 2015
4.